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Patient
74-year-old man with repeated syncopes with palpitations prior to loss of consciousness. Tracing recorded during occurrence of palpitations.
Trace
At the beginning of the tracing, atrial activity is irregular, very rapid and disorganized; it corresponds to a conducted AF with complete right bundle branch block (QRS > 120 ms, rsR' pattern in V1, wide and slurring S wave in V6); atrial arrhythmia is reduced with evidence of a post-tachycardia sinus pause of more than 2 seconds; resumption of normal sinus activity with the same pattern of right bundle branch block.
Exergue
The occurrence of a post-tachycardia pause after an episode of atrial arrhythmia should be considered in a patient with atrial fibrillation or flutter and syncope.
This type of tracing corresponds to a variant of atrial disease, associating episodes of atrial fibrillation and pauses occurring only at the time of the end of arrhythmia.